By Matt Harrington, BCBA · Behaviorist Book Club · April 2026 · 12 min read

Scope of Competence in Sexuality: A Critical Skill Gap for Behavior Analysts

Overview & Clinical Significance

Scope of competence is one of the most frequently encountered ethical dilemmas in behavior analysis, and nowhere is this more pressing than in the area of sexuality. This course, presented by Shane Spiker, directly addresses the gap between the near-certainty that behavior analysts will encounter sexuality-related behavioral concerns during their careers and the stark reality that most graduate training programs provide little to no preparation in this area.

The clinical significance is immediate and consequential. Behavior analysts working with individuals across the lifespan will encounter clients who engage in public sexual behavior, have questions about relationships and intimacy, demonstrate inappropriate sexual behavior toward others, are victims of sexual abuse, or are navigating gender identity and sexual orientation. These presentations require specialized knowledge that goes beyond standard behavior-analytic training in areas such as functional assessment and skills-based interventions.

The demand for behavior-analytic services related to sexuality has increased as the field has expanded into adult services, residential settings, and community-based programming. Individuals with intellectual and developmental disabilities have historically been denied access to comprehensive sexuality education, resulting in behavioral presentations that are often misunderstood or inappropriately addressed. When behavior analysts without adequate training in sexuality attempt to address these concerns, the risks include ineffective intervention, violation of client dignity and autonomy, and potential harm.

Spiker's presentation provides a structured approach to this dilemma by offering strategies for evaluating one's own competence in sexuality-related areas, identifying assessment tools that help practitioners determine their readiness to address specific concerns, and creating professional development goals that build competence over time. This approach recognizes that scope of competence is not a fixed boundary but a dynamic professional attribute that can be expanded through deliberate training, supervision, and mentorship.

The course also addresses the systemic factors that contribute to the competence gap. Graduate training programs in behavior analysis have historically emphasized the principles and procedures of behavior change while devoting limited attention to content areas like sexuality. Supervision experiences rarely include structured exposure to sexuality-related cases. The result is a workforce that is technically skilled in behavior-analytic procedures but unprepared to apply those procedures to one of the most sensitive and consequential areas of human behavior.

The urgency of this topic is underscored by the potential consequences of incompetent practice. Sexuality-related behavioral concerns that are poorly assessed or inappropriately treated can lead to increased restrictive practices, loss of client autonomy, damage to therapeutic relationships, and legal liability. Conversely, competent practice in this area can dramatically improve quality of life, promote healthy relationships, and protect clients from exploitation and abuse.

Background & Context

The intersection of sexuality and behavior analysis has a complicated history. For decades, the field's engagement with sexuality was limited primarily to the reduction of problematic sexual behavior, often using aversive procedures that reflected the cultural attitudes of their time rather than evidence-based best practices. This history has left a legacy of discomfort and avoidance that continues to influence how behavior analysts approach sexuality-related concerns today.

The broader context of sexuality education and services for individuals with intellectual and developmental disabilities is equally relevant. Historically, this population was institutionalized and denied basic rights, including the right to sexual expression and education. The deinstitutionalization movement of the latter twentieth century brought individuals into community settings where opportunities for social and sexual interaction increased, but without corresponding increases in education, support, and professional services.

The current landscape presents behavior analysts with a population that often lacks foundational knowledge about sexuality, has limited social skills for navigating relationships, may have experienced sexual abuse or exploitation, and demonstrates behavioral presentations related to sexuality that require specialized intervention. The contrast between the scope of this need and the preparation of the workforce to address it represents one of the most significant competence gaps in the field.

Scope of competence as an ethical concept has evolved considerably within behavior analysis. Earlier ethical guidelines addressed competence in relatively broad terms, requiring practitioners to operate within the boundaries of their training and experience. The 2022 BACB Ethics Code provides more specific guidance while maintaining the core principle that behavior analysts should not provide services in areas where they lack competence.

The challenge with sexuality is that the boundaries of competence are not always clear. A behavior analyst might be competent to conduct a functional assessment of public disrobing behavior but lack the knowledge needed to design a comprehensive sexuality education program. They might be able to implement a skills-based intervention for social boundaries but be unprepared to address questions about sexual orientation or gender identity that arise during treatment. The multidimensional nature of sexuality-related competence requires practitioners to assess their readiness across multiple domains rather than making a single competence determination.

Professional development resources for building competence in sexuality have expanded in recent years. Several organizations offer training specifically designed for behavior analysts and related professionals working with individuals with disabilities. Interdisciplinary collaboration with professionals in fields such as sex therapy, sexuality education, and reproductive health provides additional avenues for competence development. However, accessing these resources requires practitioners to first acknowledge their competence limitations, which the field's culture of avoidance around sexuality has historically discouraged.

Clinical Implications

The clinical implications of addressing scope of competence in sexuality are far-reaching and affect assessment, intervention design, implementation, and the overall quality of life of the individuals served.

During assessment, behavior analysts encountering sexuality-related behavioral concerns must first determine whether the behavior requires a clinical response at all. Not all sexual behavior is problematic. Developmentally appropriate sexual behavior, private sexual behavior, and consensual sexual behavior between adults are not clinical targets. The tendency to pathologize all sexual behavior among individuals with disabilities reflects ableist assumptions rather than clinical judgment. A competent assessment distinguishes between behavior that poses safety risks or interferes with functioning and behavior that is normative but occurring in inappropriate contexts.

Functional assessment of sexuality-related behavior requires attention to variables that may not be part of standard assessment protocols. Motivating operations related to sexual behavior may include physiological arousal cycles, environmental conditions that restrict privacy, social isolation that limits opportunities for age-appropriate sexual expression, and the absence of sexuality education that would provide the individual with knowledge about appropriate contexts and boundaries. Without understanding these variables, behavior analysts risk targeting behavior for reduction without addressing its underlying function.

Intervention design for sexuality-related concerns should emphasize skill building rather than behavior reduction whenever possible. Teaching appropriate contexts for sexual behavior, social skills for navigating relationships, personal safety skills to prevent exploitation, and communication skills to express needs and boundaries are all within the scope of behavior-analytic practice when the practitioner has adequate training. Restrictive interventions targeting sexual behavior should be considered only when less restrictive approaches have been attempted and the behavior poses genuine safety risks.

The issue of consent is paramount in clinical work related to sexuality. Behavior analysts must assess the individual's capacity to consent to sexual activity, which involves understanding of the nature of sexual activity, knowledge of potential consequences, ability to communicate preferences, and freedom from coercion. When consent capacity is in question, the behavior analyst's role is to build the skills needed for informed consent rather than to restrict sexual expression preemptively.

Collaboration with other professionals is often essential for competent practice in this area. Behavior analysts may need to consult with sexuality educators, medical professionals, psychologists, and legal experts depending on the specific concerns presented. Knowing when and how to access these collaborative resources is itself a competence that practitioners must develop.

Documentation and communication with caregivers and team members present additional clinical challenges. Discussions about sexuality may be uncomfortable for family members, direct care staff, or educational professionals. Behavior analysts must navigate these conversations with sensitivity while maintaining their professional obligation to address the client's needs. This requires communication skills that go beyond clinical terminology to include empathy, cultural awareness, and the ability to normalize conversations about sexuality.

Ethical Considerations

The ethical dimensions of scope of competence in sexuality are among the most complex that behavior analysts face. Multiple provisions of the 2022 BACB Ethics Code apply directly to this area.

Code 1.05 (Scope of Competence) is the foundational ethical standard. Behavior analysts must practice within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, and professional experience. When encountering sexuality-related concerns that fall outside their competence, behavior analysts have several ethical options: obtain additional training to expand their competence, seek supervision from a professional with relevant expertise, refer the client to a more qualified provider, or collaborate with interdisciplinary team members who possess the necessary competence.

The ethical complication arises from the scarcity of qualified providers. In many geographic areas, there are no behavior analysts with specialized competence in sexuality. Referring a client elsewhere may not be a realistic option. In these situations, the behavior analyst must weigh the potential harm of providing services outside their full competence against the harm of leaving the client without any services. This tension does not excuse practicing beyond one's competence but does require thoughtful problem-solving about how to provide the best possible care while actively pursuing additional training.

Code 2.01 (Providing Effective Treatment) requires behavior analysts to recommend and implement interventions that are supported by evidence and are in the best interest of the client. For sexuality-related concerns, effective treatment often requires going beyond standard behavior-analytic approaches to incorporate interdisciplinary knowledge from sexuality education, reproductive health, and counseling. Behavior analysts who limit their approach to behavior reduction without addressing the broader educational and support needs of the client may not be providing effective treatment, even if the specific procedures they implement are technically competent.

Code 2.14 (Restrictions on Conditions for Behavior-Change Interventions) is particularly relevant when practitioners consider restrictive approaches to sexual behavior. This code requires that behavior analysts recommend the least restrictive procedures effective for the situation and reserve more restrictive procedures for cases where less restrictive alternatives have been attempted or where the severity of the behavior justifies immediate implementation. The tendency to overreact to sexual behavior with restrictive interventions reflects discomfort rather than clinical judgment and violates this ethical principle.

Code 2.15 (Minimizing Risk of Behavior-Change Interventions) requires behavior analysts to consider the potential risks of their interventions. In the area of sexuality, risks include inadvertently suppressing healthy sexual development, creating anxiety or shame around normative sexual feelings, damaging the therapeutic relationship through invasive assessment procedures, and reinforcing the societal tendency to deny sexual agency to individuals with disabilities.

Code 3.12 (Advocating for Appropriate Services) obligates behavior analysts to advocate for services that meet their clients' needs. When organizations or systems fail to provide sexuality education, privacy accommodations, or other supports that individuals need for healthy sexual development, behavior analysts have an ethical obligation to advocate for these services. This advocacy role extends beyond individual client services to encompass systemic change.

Assessment & Decision-Making

Spiker's course emphasizes practical strategies for assessing one's own scope of competence related to sexuality and making informed decisions about professional development. This assessment process can be structured around several key dimensions.

The first dimension is knowledge. What does the behavior analyst know about human sexual development, variations in sexual expression, sexuality-related diagnoses and conditions, relevant legal frameworks, and the specific needs of the populations they serve? Knowledge gaps can be identified through self-assessment questionnaires, consultation with colleagues, and review of professional literature. These gaps form the basis for targeted professional development plans.

The second dimension is skills. Even with adequate knowledge, behavior analysts need specific clinical skills to work effectively with sexuality-related concerns. These include the ability to conduct sensitive interviews about sexual behavior and history, skill in designing and implementing sexuality education curricula, competence in assessing consent capacity, and the ability to facilitate difficult conversations with caregivers and team members about sexuality. Skills assessment should be based on direct observation and feedback from qualified supervisors rather than self-report alone.

The third dimension is comfort and attitudes. A behavior analyst may possess adequate knowledge and skills but hold attitudes or experience discomfort that interferes with competent practice. Personal discomfort with discussions of sexuality, unexamined biases about the sexual rights of individuals with disabilities, or moral or religious beliefs that conflict with professional obligations can all compromise the quality of services. Self-assessment in this area requires honest reflection and may benefit from consultation with trusted colleagues or personal therapy.

The fourth dimension is systems and supports. Competent practice in sexuality requires organizational supports including appropriate assessment tools, evidence-based curricula, supervision structures, and policies that protect both clients and practitioners. Behavior analysts should assess whether their organizational context provides these supports and, if not, advocate for their development.

Decision-making about when to provide services, when to seek additional training, and when to refer requires a structured framework. A useful decision tree might include evaluating the urgency of the clinical need, the availability of alternative providers, the behavior analyst's current competence level across all four dimensions, the availability of supervision or consultation, and the potential risks of providing versus not providing services.

Professional development goals should be specific, measurable, and time-bound. Rather than a vague goal like becoming more competent in sexuality, practitioners should identify specific competence targets such as completing a particular training program, obtaining supervised experience with a specific number of sexuality-related cases, developing proficiency with particular assessment tools, or building collaborative relationships with interdisciplinary professionals.

The concept of mentorship highlighted in this course is particularly valuable. Unlike supervision, which typically occurs within a formal professional relationship, mentorship can be more flexible and informal. Behavior analysts seeking to build competence in sexuality can benefit from mentorship relationships with experienced professionals who can provide guidance, share resources, and offer support through challenging cases.

What This Means for Your Practice

Every behavior analyst will encounter sexuality-related behavioral concerns at some point in their career. The question is not whether you will face these situations but whether you will be prepared when they arise.

Begin by conducting an honest self-assessment of your current competence across the four dimensions described above: knowledge, skills, comfort and attitudes, and systems and supports. Be specific about what you know and do not know, what you can and cannot do, and where your personal attitudes might interfere with competent practice.

Develop a concrete professional development plan based on your self-assessment. Identify training programs, workshops, and continuing education opportunities that specifically address sexuality and behavior analysis. Seek out supervision or consultation from professionals with expertise in this area. Read foundational texts on sexuality and disability from both behavior-analytic and interdisciplinary perspectives.

Establish collaborative relationships with professionals in related fields who can complement your behavior-analytic expertise. Sexuality educators, social workers specializing in disability services, and medical professionals can all contribute to more comprehensive and competent care for your clients.

Advocate within your organization for policies and resources that support competent sexuality-related services. This includes privacy accommodations for clients, evidence-based sexuality education materials, training for direct care staff, and clear protocols for addressing sexuality-related behavioral concerns.

Most importantly, resist the temptation to avoid sexuality-related concerns entirely. Avoidance does not protect your clients. It leaves them without services they need and may result in more restrictive and less dignified responses from less qualified individuals. By systematically building your competence, you can provide the evidence-based, respectful, and effective services that your clients deserve.